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Background Livedo is a well-known skin condition in patients with systemic lupus erythematosus (SLE) which correspond to small vessels involvement. The influence of antiphospholipid antibodies (aPL) on the occurrence of livedo is controversial. The aim of our study was to estimate the risk of livedo associated with aPL in patients with SLE. Methods We conducted a systematic review and meta-analysis of the literature from 1977 to 2021 to estimate the risk of livedo in SLE patients according to different aPL profiles. Data sources were PubMed, Embase, Cochrane Library, hand search, and reference lists of studies. Studies were selected if they included SLE patients with descriptions of the exposure to aPL and the outcome ( livedo). Two independent investigators assessed study eligibility, quality, and extracted patient characteristics from each study as well as exposure (aPL) and outcome ( livedo). Risk estimates were pooled using random effects models and sensitivity analyses. For all stages of the meta-analysis, we followed the PRISMA guidelines. PROSPERO registration number: CRD42015027377. Results Of the 2,355 articles identified, 27 were included with a total of 4,810 SLE patients. The frequency of livedo was 25.5% in aPL-positive patients and 13.3% in aPL-negative patients. The overall Odds Ratio (OR) for livedo in aPL-positive patients compared to aPL-negative patients was 2.91 (95% CI; 2.17–3.90). The risk of livedo was significantly increased for most of aPL subtypes, including lupus anticoagulant (LA) (OR = 4.45 [95% CI; 2.21–8.94]), IgG anticardiolipin (OR = 3.95 [95% CI; 2.34–6.65]), and IgG anti-β2-glycoprotein 1 (OR = 3.49 [95% CI; 1.68–7.27]). Conclusions We demonstrated in this meta-analysis an excess risk of livedo in aPL-positive SLE patients compared to aPL-negative patients. For daily practice, in patients with SLE, livedo associated with aPL could correspond to a peculiar group of patients with small vessel disease. Livedo could be a good candidate for inclusion in future classification criteria for antiphospholipid syndrome.

International audience

In the context of circular construction, the (potential) reuse of construction materials and building products is set forward as a general concept to reduce the environmental impact of buildings. But does this really lead to reduced impacts? A standardised framework to calculate the environmental impact of buildings over their life cycle is available through the European standards EN15804+A2 and EN15978 for life cycle analysis (LCA) in construction. The concept of reuse does however intrinsically focus on multiple use or life cycles. A correct quantification of the environmental impacts of reuse in buildings, requires a better understanding of the different mechanisms and issues at play. By means of critical assessment of the LCA methodology, in combination with a simplified case study, this paper provides insights in how different reuse options for products are valorised (or not) when calculating the environmental impact. It is shown that the LCA standard EN15804+A2 allows to quantify the impact related to different concepts of reuse at the beginning or the end of the considered life cycle. In general reused products will lead to larger environmental gains as the production stage (A1-A3) can be avoided. The environmental benefit related to the reusability of a product is typically reflected in a smaller difference in the end-of-life (EOL) stage (C1-C4). Also the relevance of existing concepts, such as module D, is discussed for each of the considered reuse options. Results show that module D can provide insights in the future potential of reuse (at EOL) for virgin products, but that the numbers are difficult to interpret and even misleading for reuse products. The results and discussion show the limitations of the current LCA framework for these types of products and identify the need for the integration of additional concepts to correctly valorise the potential of reusable products using LCA.

During the last decade there has been an intense public debate in the South African society on the issue of ‘whiteness’ or ‘whiteliness’. In this article the challenges whiteness and the debate surrounding it pose for practitioners of public theology in South Africa are explored. In the first part some of the origins of the debate on whiteness, as well as some of the main features of whiteness researchers identify, are traced. In the second part a brief sketch is provided of two different kinds of critical response to whiteness in the present South African society, namely critical responses to structural whiteness and critical responses of a more personal nature. In the third part the challenges the present debate on whiteness pose to public theology in South Africa are identified and discussed.

The article deals with the question: 'Is it morally acceptable for terminally ill Christians to voluntarily request medically assisted suicide or euthanasia?' After a brief discussion of relevant changes in the moral landscape over the last century, two influential, but opposite views on the normative basis for the Christian ethical assessment of medically assisted suicide and voluntary euthanasia are critically discussed. The inadequacy of both the view that the biblical message entails an absolute prohibition against these two practices, and the view that Christians have to decide on them on the basis of their own autonomy, is argued. An effort is made to demonstrate that although the biblical message does not entail an absolute prohibition it does have normative ethical implications for deciding on medically assisted suicide and voluntary euthanasia. Certain Christian beliefs encourage terminally ill Christians to live a morally responsible life until their death and cultivate a moral prejudice against taking the life of any human being. This moral prejudice can, however, in exceptional cases be outweighed by moral considerations in favour of medically assisted suicide or voluntary euthanasia.

Ziel der vorliegenden kontrollierten randomisierten Studie im Split-Mouth-Design war es zu untersuchen, ob sich das Behandlungsergebnis bei multiplen Rezessionen der Klasse III mit einer modifizierten Tunneltechnik und einem Bindegewebstransplantat unter Verwendung von Schmelzmatrixproteinen gegenuber dem blosen chirurgischen Verfahren verbessert. In die Studie wurden an einer Klinik fur Parodontologie insgesamt 20 gesunde Probanden im durchschnittlichen Alter von 31,7 Jahren aufgenommen. Die Patienten hatten mindestens 3 benachbarte Gingivarezessionen auf beiden Seiten eines Kiefers. Sie wurden mithilfe einer modifizierten Tunneltechnik und einem Bindegewebstransplantat behandelt. Auf der Testseite wurde zusatzlich ein Schmelzmatrixprotein verwendet. Zu Beginn der Studie, nach 28 Tagen sowie 3, 6 und 12 Monate spater wurden klinische Befunde erhoben. Die Ergebnisse werden patientenbezogen vorgelegt. Die durchschnittliche Wurzeldeckung betrug nach einem Jahr in der Testgruppe 82% und in der Kontrollgruppe 83%. Eine vollstandige Wurzeldeckung fand sich nach einem Jahr bei insgesamt 8 (38%) der 20 Operationen (Test- und Kontrollgruppe). Die Ergebnisse nach einem Jahr lassen darauf schliesen, dass die modifizierte Tunneltechnik in Verbindung mit einem Bindegewebstransplantat zu vorhersagbaren Ergebnissen bei der Behandlung von multiplen Gingivarezessionen der Klasse III fuhrt. Die zusatzliche Verwendung von Schmelzmatrixproteinen hatte keine Auswirkungen auf die durchschnittlichen klinischen Ergebnisse.

Neutropenic episodes in kidney transplant patients are poorly characterized. In this retrospective study, neutropenia was experienced by 112/395 patients (28%) during the first year posttransplant. The only factor found to be significantly associated with the occurrence of neutropenia was combined tacrolimus-mycophenolate therapy (p0.001). Neutropenic patients experienced more bacterial infections (43% vs. 32%, p = 0.04). Grade of neutropenia correlated with the global risk of infection. Discontinuation of mycophenolic acid (MPA) due to neutropenia was associated with an increased incidence of acute rejection (odds ratios per day 1.11, 95% confidence intervals 1.02-1.22) but not with reduced renal function at 1 year. The time from onset of neutropenia to MPA discontinuation correlated with the duration of neutropenia. Granulocyte colony-stimulating factor (G-CSF) administration was safe and effective in severely neutropenic kidney graft recipients, with absolute neutrophil count1000/microL achieved in a mean of 1.5+/-0.5 days. Neutropenia is an important and frequent laboratory finding that may exert a significant influence on outcomes in kidney transplantation. As well as leading to an increased incidence of infection, it is associated with a higher rate of allograft rejection if MPA is discontinued for6 days (p = 0.02). G-CSF accelerates recovery of neutropenia and may be a good therapeutic alternative for severely neutropenic patients.

The article addresses the question: ‘To what extent can Max Weber’s ethic of responsibility be a helpful resource in the search of Christian Social Ethics for an appropriate contemporary approach’? This question is addressed by, first of all, providing a summary of Weber’s famous speech Politics as a Vocation in which he developed his view on the ethic of responsibility; secondly, providing an interpretation of his view; and, thirdly, critically discussing the extent to which this ethic can serve as a resource for Christian Social Ethics in its search for an appropriate contemporary approach. The conclusion is that although some aspects of Weber’s view on the ethic of responsibility are unacceptable to Christian Social Ethics, the core of it is commendable. Some of the implications of incorporating an ethic of responsibility approach in Christian Social Ethics are also briefly discussed.

Resume Introduction et objectifs – A l’heure actuelle il apparait un interet de plus en plus important pour l’evaluation de la qualite de vie, que ce soit en pathologie mentale et plus particulierement chez le sujet schizophrene ou en sante publique. Son utilisation est destinee non seulement a evaluer la perception qu’a un sujet de sa propre vie dans un contexte qui lui est propre, mais egalement l’impact que peuvent avoir ses traitements et sa maladie. La qualite de vie est donc un des elements principaux qui doivent contribuer a la decision medicale. Toutefois, il apparait necessaire de redefinir ce qu’est la qualite de vie chez le sujet schizophrene et la pertinence des instruments d’evaluation utilises jusqu’a present. C’est dans ce contexte que nous avons cree, selon le point de vue du patient, et valide une nouvelle echelle de qualite de vie utilisable sous forme d’autoquestionnaire. Methodes - Trois etapes majeures ont ete realisees : 1) La premiere etape a consiste a identifier et a interviewer (par des psychologues) un panel de 100 patients souffrant de schizophrenie (DSM IV), le personnel soignant (n = 20) et la famille (n = 20). 2) Le verbatim ainsi constitue a servi de base de travail a un groupe de 25 experts, qui a in fine consensuellement propose une premiere version (VF1) constituee de 133 items repartis en 17 domaines. 3) A partir des donnees de J0, d’un suivi prospectif observationnel, 337 psychiatres ont inclus pres de 700 sujets afin de permettre la validation et la mise en evidence des proprietes psychometriques de cet instrument. Par ailleurs, une cohorte independante de 100 sujets a ete constituee afin d’evaluer la fiabilite de l’echelle au travers de deux evaluations (J0 et J7). Resultats - Un total de 686 patients presentant un diagnostic de schizophrenie (85,1 %) ou de type schizoaffectif (14,9 %) ont ete inclus. La structure de l’echelle SOL (The Schizophrenia Quality Of Life) apres une analyse exploratoire (ACP) a permis d’identifier 74 items repartis en 14 dimensions avec une valeur d’α de Cronbach comprise entre 0,75 et 0,95 : vie professionnelle = 0,95 ; vie affective et sexuelle = 0,92 ; connaissance de la maladie : 0,90 ; relations en general : 0,92 ; satisfaction de vie : 0,87 ; rapport aux medicaments = 079 ; effet des medicaments sur le corps = 0,87 ; vie quotidienne = 0,83 ; relations familiales = 0,81 ; avenir = 0,88 ; sentiment de securite = 0,84 ; loisirs = 0,87 ; argent = 0,76 et autonomie = 0,75. Une bonne validite concourante a ete etablie en correlation (Person) avec l’echelle BPRS et le questionnaire CGI (aspect clinique), l’echelle EAPS (aspect social) et l’echelle generique de qualite de vie RFS. Le coefficient de correlation est significatif pour tous les facteurs sauf 2 avec la BPRS et 3 avec la CGI. L’analyse test/retest indique une bonne fiabilite et reproductibilite pour chaque facteur (p

The basic treatment of chronic periodontitis is a mechanical debridement of periodontal pockets by scaling and root planing (S/RP) in combination with efficient plaque control. Locally delivered antiseptics (LDA) have been proposed to practitioners and, while subgingival irrigation of antiseptics is still used in clinical practice, the introduction in our therapy of a slow release and subgingival delivery of tetracycline has changed the rationale from a mechanical treatment towards a combined therapy for full mouth/sites disinfection. Various antibiotics, antiseptics and resorbable carriers are now proposed with similar targets to arrest disease progression. In chronic periodontitis, LDA cannot be used routinely in combination with S/RP, because of the limited clinical benefit, even if an Increased percentage of deep sites may show an improvement. Prospective multicenter studies considering risk factors for disease progression have to be designed to identify patients who may benefit the most from LDA. For non-responding sites or recurrent pockets, the controversies are limited, because a combined S/RP and LDA may avoid the need for surgery. However, the patient cost/benefit ratio needs to be estimated as well as adverse effects in particular antibiotics.

In the article the interpretation of Eduard Todt’s theory of the formation of moral judgements as descriptive of the six steps that are logically presupposed in the formation of all moral judgements is critically discussed. On the basis of an analysis of the four publications in which Todt developed his theory it is demonstrated in the first part of the article that such an interpretation is incorrect. The normative nature of his theory is acknowledged. In the second part of the article a case is made for an ethics of responsibility reading of his theory. Each of the six steps in the process of the formation of moral judgements that Todt distinguishes, is analysed. It is demonstrated that each of these steps entails a distinctive normative ethical approach that can be depicted as ethics of responsibility.

Alzheimer's disease (AD) has heterogeneous pathology, in part due to the large subset of cases (AD+CVD) with superimposed vascular lesions that are sufficient in number and distribution to accelerate the clinical course of dementia. Brains with AD+CVD have lower densities of neurofibrillary tangles and A beta-amyloid diffuse plaques, and increased numbers of cerebral vessels exhibiting p53-associated apoptosis relative to brains with uncomplicated AD. AD and AD+CVD both exhibit altered expression of the nitric oxide synthase 3 (NOS-III) gene; however, in AD+CVD, reduced NOS-III expression in cerebral vessels is associated with an increased frequency of vascular lesions, vascular smooth muscle cell apoptosis, and A beta-amyloid plaques. In contrast, experimental and spontaneous focal acute and subacute cerebral infarcts are associated with increased NOS-III expression in perifocal neurons, glial cells, cerebrovascular smooth muscle and endothelial cells, and diffuse A beta-amyloid plaque formation. This suggests that ischemic injury and oxidative stress can precipitate NOS-III-mediated cell loss and neurodegeneration. A role for aging-associated impaired mitochondrial function as a contributing factor in AD and CVD is suggested by the reduced levels of mitochondrial protein observed in AD and AD+CVD cortical neurons and vascular smooth muscle and endothelial cells. The aggregate findings suggest that cell loss and neurodegeneration may be mediated by somewhat distinct but overlapping mechanisms in AD and AD+CVD.

The efficacy in restoring a buccal dehiscence after tooth extraction has been studied in 12 consecutive cases using guided bone regeneration with (6 patients) or without (6 patients) a biomaterial (DFDBA or Bio Oss) beneath an e-PTFE membrane. A correlation between the clinical impression of density at drilling time and the histological signs of bone formation has been evaluated too. The membrane was removed after 6 or 9 months and a biopsy was performed. Clinically, GBR was highly predictable for regeneration of the alveolar bone after tooth extraction with buccal dehiscence. The histology fully confirmed the clinical and radiographical results, showing bone formation in all cases with individual variations in the amount of bone formed. 6-month biopsies from the membrane sites had lamellar bone with large medullary spaces, while a good bone density was observed at 9 months. The membrane/biomaterial sites demonstrated mineralization and large amounts of allograft at 6 months. Thus, bone regeneration seems to take more time when grafting material is used.

In the article the view that was expressed in, inter alia, the Kairos Document, that the prophetic and reformist approaches in Christian Ethics exclude one another, was challenged. A case was argued against this view by drawing on Reinhard Kratz’s book on the latest research findings on prophecy in the Old Testament, James Gustafson’s distinction of four modes of moral discourse and Walter Brueggemann’s view that prophetic texts are acts of imagination that offer and purpose ‘alternative worlds’. The conclusion was that the prophetic and reformist approaches rather complement, overlap and interpenetrate one another. In the last part of the article an argument was presented that both of the two approaches can be accommodated and integrated in a Christian ethics of responsibility. Sluit die profetiese en hervormingsbenaderings in die Christelike etiek mekaar uit? ‘n Verantwoordelikheidsetiese poging tot versoening. In die artikel is standpunt ingeneem teen die beskouing wat onder andere in die Kairos Dokument uitdrukking vind, dat die profetiese en hervormingsbenaderings in die Christelike Etiek mekaar uitsluit. ‘n Saak is beredeneer teen hierdie beskouing met ‘n beroep op Reinhard Kratz se boek oor die nuutste bevindings oor Ou Testamentiese profesie, James Gustafson se onderskeiding van vier modi van morele diskoers en Walter Brueggemann se beskouing dat profetiese tekste verbeeldingryk aan ons die moontlikheid van ‘n alternatiewe wêreld voorhou. Die gevolgtrekking was dat die profetiese en hervormingsbenaderings mekaar eerder aanvul, oorvleuel en bevrug. In die laaste gedeelte van die artikel was geredeneer dat beide hierdie benaderings geakkommodeer en geïntegreer kan word in ‘n Christelike etiek van verantwoordelikheid.

In the article the view that was expressed in, inter alia, the Kairos Document, that the prophetic and reformist approaches in Christian Ethics exclude one another, was challenged. A case was argued against this view by drawing on Reinhard Kratz's book on the latest research findings on prophecy in the Old Testament, James Gustafson's distinction of four modes of moral discourse and Walter Brueggemann's view that prophetic texts are acts of imagination that offer and purpose 'alternative worlds'. The conclusion was that the prophetic and reformist approaches rather complement, overlap and interpenetrate one another. In the last part of the article an argument was presented that both of the two approaches can be accommodated and integrated in a Christian ethics of responsibility. In die artikel is standpunt ingeneem teen die beskouing wat onder andere in die Kairos Dokument uitdrukking vind, dat die profetiese en hervormingsbenaderings in die Christelike Etiek mekaar uitsluit. 'n Saak is beredeneer teen hierdie beskouing met 'n beroep op Reinhard Kratz se boek oor die nuutste bevindings oor Ou Testamentiese profesie, James Gustafson se onderskeiding van vier modi van morele diskoers en Walter Brueggemann se beskouing dat profetiese tekste verbeeldingryk aan ons die moontlikheid van 'n alternatiewe wêreld voorhou. Die gevolgtrekking was dat die profetiese en hervormingsbenaderings mekaar eerder aanvul, oorvleuel en bevrug. In die laaste gedeelte van die artikel was geredeneer dat beide hierdie benaderings geakkommodeer en geïntegreer kan word in 'n Christelike etiek van verantwoordelikheid.

I completed my doctoral dissertation on The distinctiveness of Christian morality in 1978. In this article, now more than 30 years later, I critically examined the extent to which the view that I developed in my doctoral dissertation is still valid today and to what extent it stands to be corrected in the light of developments in Christian ethics in the meantime. Firstly, I provided a brief summary of the view developed in the dissertation. Secondly, I discussed the influential alternative view of Stanley Hauerwas and attempted to identify ways in which his view necessitates corrections to my own view in the dissertation. Thirdly, I criticised the one-sidedness of Hauerwas's view on the distinctiveness of Christian morality and discussed ways in which we need to go beyond Hauerwas's view in order to develop a more satisfactory and also more inclusive approach.

Forty-nine patients admitted for assessment of chest pain underwent coronary angiography, planar Thallium 201 myocardial scintigraphy after submaximal exercise (TE) and transoesophageal atrial pacing (TAP). Early hypofixation with redistribution after 4 h indicated ischaemia. The criterion for a myocardial infarction (MI) was a fixed perfusion defect. Coronary angiography was carried out in all patients. Sixteen patients (group 1) had no MI and over 50% narrowing of at least one main coronary vessel. Ischaemia was noted in 10 of the 16 patients during exercise, and in 14 of the 16 patients during atrial pacing. The sensitivity for the prediction of coronary stenosis was 62% for TE and 87% for TAP. Nineteen patients (group 2) had had a previous MI. Reversible ischaemia was noted in 10 of the 19 patients during exercise, and in 11 of the 19 patients during TAP. Four of 14 patients with normal coronary arteries (group 3) had a reversible ischaemia with TE, and three of these same patients developed a positive scan with TAP. The respective specificities were 71% and 78%. Comparison of segmental hypoperfusion after TE and TAP gave identical results in 72 of the 80 segments studied in group I (90%), and in 88 of the 95 segments studied in group 2 (92%). The localizing value of TAP was good in left anterior descending (12 out of 18) and right coronary disease (16 out of 19), but poor in left circumflex stenosis (3 out of 9) misclassified as right coronary disease in four patients.(ABSTRACT TRUNCATED AT 250 WORDS)

The tolerance and pharmacokinetic behaviour of a new injectable streptogramin antibiotic, RP 59500 were evaluated on 26 healthy male volunteers in a double-blind, placebo-controlled, phase I study. The doses used were 1.4, 2.8, 4.6, 7.0, 9.8, 12.6, 16.8, 22.4 and 29.4 mg/kg; each dose was administered as a 1 h infusion to eight subjects, two of them receiving placebo. Blood levels of RP 59500 were measured by both microbiological and HPLC assays. At the end of the infusion, Cmax for RP 59500 ranged from 0.95 +/- 0.22 to 24.20 +/- 8.82 mg/L. The apparent elimination half-life of the compound ranged from 1.27 to 1.53 h. RP 59500 did not significantly affect any of the laboratory or clinical assessments (blood pressure, pulse rate, ECG, peak expiratory flow rate). Reported adverse effects were of mild intensity; the most frequent event was mild pain or burning at the infusion site with doses of 7 mg/kg or higher. These results support further studies of RP 59500 in phase II clinical trials.

Bovine oocytes were partly denuded either at the beginning (t0) or six hours (t6) after the beginning of maturation and vitrified by the open pulled straw method at the end of the maturation process. After warming and fertilisation, their development in vitro and in vivo was assessed. The rates of production of blastocysts achieved in vitro were 3.4 per cent for the t0 group and 0.9 per cent for the t6 group compared with 40.4 per cent for the control oocytes. After transfer at the blastocyst stage pregnancies have been established in the three groups. Some of these pregnancies originated from vitrified oocytes which were further vitrified at the blastocyst stage before being transferred into synchronised recipients.